Cerebral veno-occlusive disease: CT and MRI findings

Cerebral venous thrombosis [CVT] is an elusive diagnosis because of its nonspecific presentation and its numerous predisposing causes. Veno-occlusive disease of the brain most commonly affects the superior sagittal sinus followed by the transverse, sigmoid and straight sinuses. Cerebral venous thrombosis often presents with hemorrhagic infarction in areas atypical for arterial vascular distribution. It is more common than previously thought. Imaging plays a key role in the diagnosis. Magnetic resonance venography [MRV] in conjunction with t conventional MRI can accurately diagnose cerebral venous thrombosis. The aim of the study is to illustrate the spectrum of CT and MRI findings in cerebral veno-occlusive disease. In a retrospective study, twenty patients with a final diagnosis of cerebral veno-occlusive disease constituted the subjects of the study. The mode of onset was acute [first neurological symptoms or signs < 48 hours] in 8 patients and sub-acute [48 hours to one month] in 12 patients. Each patient was subjected to history taking, clinical evaluation, pre and past contrast enhanced CT scans, T1 SE, T2 SE, and FLAIR conventional MRI and together with MRV. MRI was performed immediately after CT scan in only 4/8 acute patients and delayed in mean duration of 11.3 days in the other four acute patients while it followed CT scans in all subacute twelve patients [mean duration of 1.5 days].. CT scan was unremarkable in 8/8 patients and abnormal in 12/12 patients. Abnormal findings included cerebral [8/12] or cerebellar [4/12] and the infarctions which was hemorrhagic in 5/12 patients. An empty delta sign was the only direct CT finding of CVT in only one patient MRV examination showed absent flow signals in 39 sites of thrombosis in all patients notably the superior sagittal sinus which was thrombosed in 17/20 patients followed by the transverse sinus in 13/20 patients, the sigmoid sinus in 7/20 patients and the straight sinus in 2/20 patients. Conventional MRI revealed 36 sites of dural venous sinuses thrombosis while failed to directly diagnosis two sites of superior sagittal sinus thrombosis and one site of transverse sinus thrombosis in 3/4 acute patients. CT examination in patients with suspected CVT serves mainly to depict secondary changes in the brain parenchyma, such as venous infarcts or edema and serves to exclude other abnormalities in the initial workup. The diagnosis of cerebro-vascular thrombosis occasionally can be made by CT scan with careful attention to the findings, which may be subtle. MRI combined with MRV is reliable as the sole examination for this condition

Ultrasound guided reduction of primary intussusception presented with simple intestinal obstruction using saline enema as a new hydrostatic-experienced technique

Ultrasound guided hydrostatic reduction is used as a routine in all cases of primary early non-complicated intussusception with a very high success rate. We observed from our experience some cases of primary intussusception presented by simple intestinal obstruction usually of long duration [3-5 days]. After diagnosis of these cases, exploration was indicated and easy simple reduction was done for all. A prospective study in 25 patients admitted to the Pediatric Surgery Department. Faculty of Medicine, Alexandria University, Egypt, between September 1996 and August 1997. Those patients were diagnosed and assessed clinically as primary intussusception presenting with simple intestinal obstruction [Abdominal distention, vomiting, no abdominal tenderness and no rigidity with multiple air fluid level], plain x-ray abdomen standing was done for all cases and the diagnosis may be confirmed by using ultrasonography and using warmed saline enema, ultrasound guided hydrostatic reduction for all patients. This study included 25 cases of primary intussusception presented by simple intestinal obstruction without abdominal rigidity and tenderness as appropriate candidates for a trial of hydrostatic pressure using saline enema under the ultrasonic scanning guidance. The intussusception was successfully reduced in 20 patients with a mean hospital stay of 12 hours. The; they received oral meals after a mean time of 14 hours. While children with operative intervention had a mean hospital stay of 4.5 days, and received oral feeds after a mean time of 3.1 days. Ultrasound guided reduction of primary intussusception presented by simple intestinal obstruction in clinically and radiologically selected patients. Using saline enema is a new technique and must be tried in every selected case